Transcript Community Mental Health and Substance Abuse Services Section

System Transformation
in Texas:
Agenda for 2006-2007
Dave Wanser Ph.D.
Deputy Commissioner for Behavioral and
Community Health
Department of State Health Services
Current Behavioral
Health Care System
“For too many Americans,
the services and supports they need
remain fragmented, disconnected,
and often inadequate, frustrating the
opportunity for recovery….
Instead of ready access to care, the
system presents barriers that all too
often add to the burden of mental
illness (and substance abuse) for
individuals, their families, and our
communities.”
Achieving the Promise:
Transforming Health Care in America
The Texas Approach to
Transformation
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Overarching goal is to improve the mental health of all
Texans and meet the President’s NFC goals.
New Freedom Commission Goals are shared by those
participating on the TWG:

The Governor’s Office; Department of State Health
Services; Texas Health and Human Services Commission
(Medicaid); Department of Family and Protective Services;
Criminal Justice Department; Juvenile Probation
Commission; Texas Youth Commission; Consumers; Family
Members; Texas Education Agency; Aging and Disability
Services; Workforce Commission; Veteran’s Administration;
etc.
TWG Agency Resources Spent on Mental Health
05
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($1.003 Billion)
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The Texas Approach to
Transformation

The grant funding is seen as a catalyst to jump start some of the
efforts of framing the public health approach. The 2 primary
areas of focus:
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Developing and supporting local behavioral health collaboratives
Using cutting edge technology to change work processes across
agencies
Improvement of the system will be targeted to the IOM Quality
Chasm principles:

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Apply evidence to health care delivery;
Use information technology;
Align payment policies with quality improvement;
Prepare the workforce.
Adverse Childhood Experiences as a means
to Understand the Public Health Approach
Child Abuse or Neglect
 Physical abuse
 Sexual abuse
 Abandonment
Trauma in Child’s Household
• Substance Abuse
• Parental divorce
• Mentally ill or suicidal
household member
• Violence to mother
• Imprisoned household
member
Adverse Childhood Experiences
Effects of Trauma
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Difficulty controlling anger
Hallucinations
Depression
Panic reactions
Anxiety
Health Risk Behaviors
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Smoking
Obesity
Suicide
Alcoholism
Drug abuse
Sexually transmitted disease
Self-injury
Eating disorders
Adverse Childhood Experiences
Long-Term Consequences
Disease and Disability
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Heart disease
Cancer
Chronic lung disease
Emphysema
HIV/AIDS
Social Problems
• Homeless
• Prostitution
• Delinquency, violence and
criminal behavior
• Re-victimizations: rape;
domestic violence
• Unemployment
• Intergenerational
transmission of abuse
Adverse Childhood Experiences
& Attempted Suicide
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20
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10
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Behavioral Health Issues Impact Costs
and Outcomes in Other Systems
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75% of children placed in foster care have parents with
behavioral health problems
75% of kids in the juvenile justice system have behavioral
health problems
30% of kids in the juvenile justice system will end up in the
adult justice system
46% of all ER visits have behavioral health issues as a basis
or contributing factor
30% of all truancy is related to behavioral health problems
Potential of a Public Health Approach:
What we will make a priority of all
agencies
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Focus on prevention and early intervention and adopt a
family based approach
Implement national outcome measures and focus on how
cultural issues impact disparities in access and outcome.
Expand the use of cutting edge technology
Demonstrate successful integration of physical and
behavioral health
Seek public/private partnerships
Work to develop and maintain a shared transformation
agenda with stakeholders at both the state and local level
Change minds, change systems, change behavior
Texas Transformation
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1. Texans
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Build capacity of primary care providers to identify, treat and refer across disciplines
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Use local behavioral health collaboratives to leverage policy change
2. MH
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understand mental health is essential to overall health
care is consumer and family driven
Reduce barriers to treatment and reduce stigma with new program and purchasing models
3. Disparities
are eliminated
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Inter-operability of data systems creates a roadmap for opportunities
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Leveraging lessons learned from other initiatives, e.g. work with faith community
4. Early screening, assessment and referral are common practice
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Use of technology
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ACE framework shared by member agencies
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Behavioral health/ primary care and public/private partnerships
5., 6. Excellent care is delivered and research accelerated, technology is utilized
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Demonstrate return on investment
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System wide use of evidence based frameworks and practices
A Borrowed Approach to
Community Collaboration
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Community collaboratives have been very effective in
mobilizing communities to address issues in access to
healthcare for underinsured populations
Membership consists of business leaders, elected
officials, community leaders, consumers. Providers
Follows a structured and facilitated process for needs
assessment, planning and implementation
Linkages to other local collaboratives through statewide
framework leverages political impact.
Use Technology to Transform the Mental Health System
Data produced from the interagency integrated
data base……
Transformation
Working Group
State Level
Data
Integration
System
Local
Community
Collaborative s
Community
Collaboratives ensure
Service Providers …..
….informs the Local Resource Inventory
and Needs Assessment.
Electronic Medical
Record
Service Providers
Video Conference
Capacity
Interagency
Instant Message
Capacity
Telemedicine
…..have access to
technological
innovations needed to
most efficiently deliver
services
Federated Data System